Effect of preoperative administration of allopurinol in patients undergoing surgery for valvular heart diseases☆

Talwar, Sachin; Sandeep, Janardhan Alamanda; Choudhary, Shiv Kumar; Devagourou, Velayoudam; Kasthuri, Jeeva Mani; Kumar, Arkalgud Sampath

doi:10.1016/j.ejcts.2010.01.027

Cited by 13 publications

(11 citation statements)

References 10 publications

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“…Compared with placebo, initiation of XOI prior to coronary artery bypass graft (CABG) surgery improved recovery of cardiac function, 23 maintained normal sinus rhythm after open-heart surgery, 24 and might have reduced heart muscle injury and clinical outcomes after percutaneous coronary intervention (PCI) 25 in a series of small studies. One new study 20 showed that patients with high serum urate assigned to allopurinol for three months after an acute ischemic stroke had improved functional outcome evaluated by a modified Rankin scale (OR = 4.65, p = 0.014).…”

Section: Resultsmentioning

confidence: 99%

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta‐analysis

et al. 2016

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BackgroundPrevious studies have shown that xanthine oxidase inhibitors (XOI) might improve outcome for patients with cardiovascular disease. However, more evidence is required.Methods and resultsWe published a meta‐analysis of trials conducted before 2014 examining the effects of XOI on mortality in patients with cardiovascular disease. At least two further trials (N = 323 patients) have since been published. Accordingly, we repeated our analysis after a further search for randomized controlled trials of XOI in PubMed/MEDLINE, EMBASE, and Cochrane Databases. We identified eight relevant trials with 1031 patients. The average age of the patients was 61 years and 68% were men (one study did not report gender). There were 57 deaths in these eight trials, 26 in those assigned to XOI, and 31 in those assigned to the control. The updated meta‐analysis could not confirm a reduction in mortality for patients assigned to XOI compared with placebo (odds ratio 0.84) but 95% confidence intervals were wide (0.48–1.47).ConclusionsThis updated meta‐analysis does not suggest that XOI exert a large reduction in mortality but also cannot exclude the possibility of substantial harm or benefit.

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Section: Resultsmentioning

confidence: 99%

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta‐analysis

et al. 2016

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“…Common procedures as CABG and CABG plus VR were not examined in this study. Talwar et al [29] found that preoperative allopurinol treatment in patients undergoing valvular heart surgery is associated with decreased postoperative inotropic requirement and duration of postoperative mechanical ventilation and shorter hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery

et al. 2018

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BackgroundAcute kidney injury (AKI) following cardiac surgery is a frequent complication and several risk factors increasing its incidence have already been characterized. This study evaluates the influence of preoperative increased serum uric acid (SUA) levels in comparison with other known risk factors on the incidence of AKI following cardiac surgery.MethodsDuring a period of 5 month, 247 patients underwent elective coronary artery bypass grafting, valve replacement/ repair or combined bypass and valve surgery. Datas were prospectively analyzed. Primary endpoint was the incidence of AKI as defined by the AKI criteria comparing patients with preoperative serum uric acid (SUA) levels below versus above the median. Multivariate logistic regression analysis was used to identify independent predictors of postoperative AKI.ResultsThirty (12.1%) of the 247 patients developed postoperative AKI, 24 of 30 (80%) had preoperative SUA- levels above the median (≥373 μmol/l) (OR: 4.680, CI 95% 1.840; 11.904, p = 0.001). In the multivariate analysis SUA levels above the median (OR: 5.497, CI 95% 1.772; 17.054, p = 0.003), cardiopulmonary bypass (CPB) time > 90 min (OR: 4.595, CI 95% 1.587; 13.305, p = 0.005), cardiopulmonary bypass (CPB) > 30 kg/m2 (OR: 3.208, CI 95% 1.202; 8.562; p = 0.02), and preoperative elevated serum-creatinine levels (OR: 1.015, CI 95% 1.001; 1.029, p = 0.04) were independently associated with postoperative AKI.ConclusionsSerum uric acid is an independent risk marker for AKI after cardiac surgery. From all evaluated factors it showed the highest odds ratio.

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“…The score has since been used to assess illness severity in infants and neonates undergoing cardiothoracic surgery (2–8). Recently Gaies et al introduced the vasoactive-inotropic score (VIS), which expanded on the inotrope score to include other vasoactive agents commonly used in intensive care units (ICUs) (9).…”

Section: Introductionmentioning

confidence: 99%

Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: A substudy of a randomized clinical trial

Nguyen

Havalad

Aponte-Patel

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Objective Vasoactive medications improve hemodynamics after cardiac surgery but are associated with high metabolic and arrhythmic burdens. The vasoactive-inotropic score was developed to quantify vasoactive and inotropic support after cardiac surgery in pediatric patients but might similarly be useful in adults. Accordingly, we examined the time course of this score in a substudy of the Biventricular Pacing After Cardiac Surgery trial. We hypothesized that the score would be lower in patients randomized to biventricular pacing. Methods Fifty patients selected for increased risk of left ventricular dysfunction after cardiac surgery and randomized to temporary biventricular pacing or standard of care (no pacing) after cardiopulmonary bypass were studied in a clinical trial between April 2007 and June 2011. Vasoactive agents were assessed after cardiopulmonary bypass, after sternal closure, and 0–7 hours after admission to the intensive care unit. Results Over the initial three collection points after cardiopulmonary bypass (mean duration 131 minutes), mean vasoactive-inotropic score decreased in the biventricular pacing group from 12.0±1.5 to 10.5±2.0 and increased in the standard of care group from 12.5±1.9 to 15.5±2.9. Using a linear mixed effects model, this slopes of the time courses were statistically significant (p=0.02) and remained so for the first hour in the intensive care unit. However, the difference was no longer significant beyond this point (p=0.26). Conclusions Vasoactive-inotropic score decreases in patients undergoing temporary biventricular pacing in the early postoperative period. Future studies are needed to assess the impact of this effect on arrhythmogenesis, morbidity, mortality, and hospital costs.

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Effect of preoperative administration of allopurinol in patients undergoing surgery for valvular heart diseases☆

Cited by 13 publications

References 10 publications

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta‐analysis

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta‐analysis

Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery

Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: A substudy of a randomized clinical trial

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